Join Date: Jul 2012
Location: Rutherford County, TN
The ENTIRE Application to ALJ decision process as WE know it
Okay folks, I am one of you or like one of your spouses who has fully entrenched himself in this process, or lack thereof, that regards the Social Security Disability Claims process all the way through. I normally do not ever get involved in blogging or responding to blogs at all, but in our case and dealing with the SS agency I thought it would be helpful to pay it forward a bit. I am attempting to list out the entire process as we have gone through it so that it will help some or all of you who are in the midst or beginning of the Disability claim process understand and perhaps estimate what will happen in your case.
A little background might help, first. We live in Tennessee. I have heard that TN is one of the most STRICT states on disability claims in scrutinizing evidence and making favorable decisions. In our case, this couldn't have seem to have been more true. Secondly, we are awaiting our letter from the ALJ to this day even though my wife's hearing was back on May 17, 2012. We did not get a "bench decision." Those are very, very rare. If you didn't get a bench decision DO NOT WORRY. It doesn't mean you are denied at all. I'll get to all of that in a minute. So, here we go with OUR timeline and events that have transpired:
We filed in October 2010. My wife had initially filed a different type of claim back in 2006 when her then-California state disability ran out. She suffered from breast cancer and we tried to "extend" her state benefits that only last a year. Without any knowledge of the SS Disability process or that we REALLY could've fought back then with a lawyer, we just let it go. Fast forward to 2010. My wife files because back in 2009 she was diagnosed with stage 2 Lymphedema (there are only 3 stages and this IS a 'disabling' condition - please research Lymphedema outside of this post for answers on that, please). We still had no idea, really, that the Fed Soc Sec agency was available or that it was an option until my wife went back to work, or tried to, in Oct 2010. Her then-boss told us about her ex-husband filing on his own and getting approved, etc. So then the idea was put into play to file SS.
Now, at this point we hired an attorney right away. In our minds we were thinking, hey, this came from her cancer treatments and she had it back in 2005 so can we just pick up the old claim and go forward with years and years of back payment? Our attorney was leary on this and told us that to start off the process we needed to file a NEW claim since the old one was wayyy past the 6 months we all have to appeal. There was no way the DDS (Disability Determination Service) was going to re-open that claim. BUT, we still used 2006 as her "onset" date.
Now we go into the "First step" of the process: file the claim. Everywhere you read about getting your facts, medical records, dates, symptoms, SELF-DESCRIBED PAIN, ETC. IS TRUE, FOLKS. Make sure you have EVERYTHING. Especially when it comes to your physical limitations. DO NOT underestimate or think, "well I don't want to over do it!" MAKE SURE YOU ARE VERY, VERY PRECISE. The SS DDS is LOOKING for this. They have certain lingo and phrases on your application and subsequent medical records that support a claim of disability. This is where so many people go off track. We did, too. We weren't sure and our lawyer is not really interested in getting an approval at the primary or appeals levels. They want it to go to trial. There are several unproven reasons why, but they are all most likely true. (the longer you wait for approval or the process takes, the more back pay you receive, thus, they get alllll their fees paid on back pay). So, needless to say we were denied. BUT, it looks like it was BARELY denied.....meaning it went to a "reveiwal" which is a step beyond the normal person, case worker, who works your claim. According to our lawyer, it appeared as though the case worker at SS wanted to approve it, but it went to this "reveiwal" board or process and they denied it. And my wife had over 500 pages of medical evidence.
Once we initially filed in Oct 2010, they "lost" our file and our attorney, and if you have a good one they will do this because they KNOW who to call at DDS, escalated things to the local office's "director." Meaning he had proven that faxes were sent, via confirmation reciepts, etc, and that they had truly "dropped the ball" at DDS. This, too, is a common occurence so I've read and been told by several different claimants and attorneys. So, the "director" promised to fast track our case, meaning he was escalating it to a case worker to put it up front of other cases. THEY DO..DO THIS. However, we didn't get to the med exams, etc. that SS requires until July 2011. After that and all the filings and receipts of med evidence from us our initial denial came in October of 2011. One year almost to the date.
On the primary stage, my wife did have to go see the SS doctors. That went okay, but it wasn't like they totally agreed with all of my wife's doctors. Hence, the support in denial. So we got denied. PLEASE NOTE: once, if, you are denied you are entitled to all of the documentation used in your case - whether your lawyer submitted it or the DDS filed it, you can get it on a CD. REQUEST THIS INFO IMMEDIATELY. You probably won't be able to make sense of it, but it is always nice to see what has gone on in your case. Your lawyer will also get a copy of it and it is THEIR job to make sense of it and help you win on appeal or at an ALJ hearing. A second copy never hurts. IF DDS or SS says you are NOT entitled to it: argue until you get it. This is YOUR case. IF you didn't have an attorney, you would still be able to get it regardless.
Next up was the appeal process. This was an almost automatic denial. Unless something drastic has changed in your documentation or proof, expect that you WILL be denied. It was almost a rubber stamp denial. This happened within 3 months of the first denial. We got the denial, I wanna say, in December of 2011 - late Dec early Jan.
Now, I'm not sure if the "Director's" fast tracking or escalation orders on my wife's file were still in place, but we got a hearing date within 2 - 3 months AFTER our denial. We filed the ALJ hearing in Jan 2012 and were set up for a hearing on May 17, 2012. IN THE MEANTIME OF WAITING for the ALJ appeal to be set up: I contacted our local congresswoman and did a "fax blast" to her "constituant services" (admin people that work for congresswoman) just in case. It never hurts to "be on it" when it comes to a buearocratic system, gang! I NEVER heard from their office, but we DID get a really fast response and a set hearing date. Try this no matter what.
Okay, so the hearing date is 5/17/12 and the "Vocational Expert" is at the hearing, too. DO NOT assume this person is out to get you. They are NOT. They are actually there to corroborate your disability. Your lawyer knows EXACTLY what to do, say, file, explain, etc. to the judge AND the V.E. TRUST ME. IF you are REALLY disabled, it WILL show and the V.E. will side with you. When you go to the hearing, you will go with just your attorney. Rarely will there be anyone on your side outside of that. Unless you are good friends with your dr. and they wanna take time out to go to your hearing, which they will not, then it's just you, your lawyer, the VE, ALJ and their secretary/stenographer. It is audio taped. All records are reviewed by the ALJ PRIOR to your hearing so the ALJ knows what to ask and to get right down to business. You MUST BE prepared. Your lawyer should do this a day or two before your hearing. They will help you on what to say, how to say it, etc. IF your pain level is an 8 in your eyes, you may wanna reconsider it higher if you have a higher tolerance of pain. (I'm NOT gonna TELL you to "lie" but you MUST be truthful and "in tons of pain" and "fully restricted.") My best advice is also to tell the judge everything you cannot do now that you used to be able to do. Making dinner, cleaning the house, playing tennis/golf, etc. My wife's condition is so bad that she cannot even type more than a few minutes at a time. THEY ARE LOOKING FOR THOSE ANSWERS. Give them to the ALJ. The ALJ will either determine you disabled or not and the testimony of the VE will have a HUGE bearing on that. Also keep in mind that sitting, lifting, TYPING/WRITING, reading, standing, filing papers, speaking to people without losing your train of thought, etc. ALL come into play. If it affects you - SAY IT. My wife's condition is so bad that she can't do any of this and when she was explaining it to the ALJ she couldn't help but break down in tears. I, this is ME, think this helped her become a "credible witness" in the eyes of the ALJ. The ALJ will look specifically for this credibility. IF they don't find you credible, then ALLLLL of your records and the review with the VE during your hearing will be scrutinized to the teenth exponential :-) It's hard to "fake" tears and my wife certianly had nothing to hide nor lie about.....so you all should have no problems either.
Once the ALJ is done asking you questions DO NOT TRY and "read into" their demeanor. They are TRAINED to show no emotion and to be completely objective. The ALJ will give some "scenarios" to the VE and they will use a "set standard" of jobs, duties, etc. that more than likely are VERY out dated. The Vocational Expert (I reffer to as "VE" here) will take the very medical evidence YOU provide as well as some of the SS Dr's reports and compare what you can or cannot do based on PAST work experience. Once this is determined, on the spot, they will move into "potential" jobs based on your experience, etc. and measure IF you can do any of those jobs/duties. My thinking and from what I've heard is that if the V.E. comes up with you being able to do less than 50% of the duties, this should be a good sign for you. Ideally, your lawyer should litigate or argue that down to zero pct. They probably will. Oh, you MUST include ALL medicines you take. An example of this is if you have chronic pain/Fybro as your disease: if you take painkillers, etc. and they make you drowsy, do they make you sleep alot during the day? The arguments become, "How can my client hold down a job if they need to sleep 6 of 8 working hours?" or "This medication prohibits them from operating machinery (if you are a truck driver, forklift operator, etc.). THIS IS MEGA-IMPORTANT.
Once the VE is done, and hopefully all Dr reports concur that you are 0% able to do ANY functions, you are pretty much done. Your attorney will point out all things the ALJ needs to see and consider. This is why having a lawyer is critical, folks. Most, if not all, SS Lawyers do not charge you unless you win. They are deeply invested, but make sure you research them and pick a WINNER. This choice will make or break your case, too.
Now, once my wife stepped immediately out of the ALJ room, our lawyer was very, very confident of an approval. Your attorney cannot and most likely WILL NOT say you "won" or "lost." They cannot do this because if it goes the wrong way, they might be liable for telling you that. BUT, if your lawyer is good and experienced, they will know once the hearing is over. They've been through it many, many times and are good judges of your odds on winning. Keep in mind as well and again: a "BENCH DECISION" is unlikely in most cases. Most lawyers, if not all - ours did, will request a "Bench Decision" way before your hearing date. In fact, I think there's a spot on the appeals form that allows you or your lawyer to request a bench decision. Again, most of the time this doesn't happen. The folks on here that say they got one are more-than-likely in the vast minority of those who did go to a hearing. DO NOT be discouraged if you don't get one. Consult your lawyer.
Now we are at the point of "waiting" for the letter and decision from the judge. There are several steps we have learned from THIS stage of the game. One is that a decision will take several, several weeks. More than likely it will be anywhere from 7 - 12 weeks before you know anything. This is normal. Anyone who tells you that "the longer the better" or "if you're past 90 days with no decision you are likely turned down" is WRONG. There is NO real way to predict this....lawyer or not, they DO NOT know. The DDS, ALJ and ODOAR are specifically instructed NOT to say anything to you until you get your letter in the mail. Do not even try to ask the ODOAR (I think that's the acronym lol) or to try and get the "Writer" on the phone. They will get FIRED if they even pull up your case or SSN. The "Writer" is the person who actually writes the decision and subsequent statements FOR the ALJ. Most of you know who and what the "Writer" does, so it really is that simple and it is their role in the process.
Post hearing: ALJ makes their decision (ours was only DAYS after the hearing) - this can take a week or 5 or 100 depending on workload and each case. A "Writer" is assigned to write your case's decision. This usually takes 4 - 8 weeks depending on workload, etc. They send it BACK to the ALJ to review. The ALJ often, very often, times will send it BACK to the writer to fix anything they missed or that's not in there (this could also take several weeks). The "writer" sends it BACK to the ALJ. IF everything is in line the judge reviews the "final" copy, signs it THEMSELVES and usually has their secretary mail it out. This can take several days or weeks for them to actually "sign" it and their secretary to actually mail it. Then you have the US Postal service: you're at their mercy, so don't stalk your mail carrier lol!
One last point on the ALJ to Writer process...based on what I read and could decipher on the SS website....the process of sending your file/case to and from each person is "housed" in an electronic "filing" system or database of some sort. This means that they have a software or some other program that holds all cases assigned to either that ALJ or that hearing office. Your ALJ will have all of your info put into your own special "file" that will be accessed in this "housing" folder or what have you. So, the ALJ spends much, much time opening and closing your file until they are ready to pass it along. The assigned writer then accesses your file in that same "housing" system. They do their work. Once it's done they save it and somehow the ALJ is notified that your file is ready to review. The ALJ goes back into the "housing" system and reviews everything and so on. My point is that IF you call DDS or the ODOAR they will tell you different "dates" on this process. It is somewhat accruate. This is what happened to us: Our file was "sent" to the writer on let's say 5/22/12. That date was recorded and shown to have been sent to the "writer." The "Writer" accessed the file on let's say 6/9/12. Just to WORK on it. They sent it BACK to the ALJ to review on 6/29/12 lets say. And the ALJ had it ready to print, sign and mail as of 7/10/2012 let's say. EACH time you all the main soc sec office this date WILL change. It's not that it's inaccurate or, in most cases or people's "claims," that they don't know what they are talking about....it's BECAUSE of this "housing" or filing system that each time it is ACCESSED or WORKED a different date will show to the rep you are speaking to at the time. It is showing a "progression" pattern if you will. I would keep these dates in mind because we ALL want to know SOMETHING....especially when our fate is in the hands of some stranger being asked to make or break our financial future.
Last thing, and I know this has been a HUGE blog....I REALLY, REALLY understand what everyone on here is going through. TRUST ME. I have been as accurate and descriptive as possible so that you, too, can take some solace or gain some piece of mind that the SS agency does not, nor ever will, give us. I hope you all have found some value in this blog. More importantly, if you TRULY are disabled, I wish you Godspeed and the benefits you DESERVE.
Remember: BE PATIENT. DO NOT spend what you do not have in your pocket! HIRE A LAWYER ASAP. I CANNOT say this enough. BE DESCRIPTIVE. Rely on those around you for support. And, Please, what I have posted here is just based on my experience in the state of Tennessee. ALL cases are different, but I feel like ours was in the "vast majority" to where it will help you in some capacity. I am in NO WAY a professional nor someone who can give that advice. My statements here are NOT to be construed as any guarantees nor accurate to anyone else aside from me and my family. If I have made any errors in typing or otherwise, I beg forgiveness.
This whole process is enough to drive ANYONE crazy and it causes sooooo much pain, uneasiness, anxiety and just overall HE!! I encourage you to pass along my/our experiences to other sites via copy-and-paste so that these types of things can be shared with others. Knowledge is not only power, it is a GREAT sedative in THIS process. I hope that more and more people will pass this along, write their OWN experiences of facts and keep communicating. I am ever-grateful to those that have done so for me and my wife. THANK YOU FOR THAT. Please do the same. If you go to another, legitimate, honorable site/blog space PLEASE feel free to, again, pass my story along to others. We all know how painful it is to be denied, wait for ANYTHING to happen and then WAIT yet again for a simple ANSWER while all the time suffering greatly because there is such a lack of respect, dilligence and morality amongst those in need. REMEMBER ALSO: THIS IS A TAX we pay. FOR INSURANCE. In MY opinion, those who ARE disable should fight, fight, fight until you get what is entitled to you. DON'T GIVE UP.
Last, last thing...and I actually need help on this: If anyone can tell me how long it took from when the ALJ "signs off" for final judgment, how many days does it usually take to get that in the mail? Our ALJ had it to sign as of 7/11/2012, but it didn't look like he had actually pulled it up again to print and sign and mail. If you can let me know I would be equally as grateful.
Thank you and GOD BLESS you all.....Oh, and please don't forget to let me know if you have any idea about how long it takes from when the ALJ has the "final" decision to print, sign and mail (again, we were told late last week he had it and just need to sign it and mail it to us) out.